What's the best way to get rid of acne scars?

There are generally three viable alternatives that we utilize on a regular basis:

1. Erbium Laser which generally works with one treatment, but can be repeated if desired.
2. Fraxel Laser which generally provides some improvement after 5 or 6 treatments.
3. Injectables to fill the acne scars. This provides temporary but quick improvement of acne scars.

With any of these alternatives, you should find an experienced practitioner who is well trained.

Acne scars can be a devastating condition, and they have been notoriously difficult to treat. As noted by other physicians, they are almost impossible to remove completely, but we have many options to make the appearance of the scars much better.

There are different types of scars: some are shallow and gradual, some are deep - "ice-pick" scars - some are pigmented. Usually, it is the depth differential between the scar and surrounding skin that creates a light-shadow interface, and makes them prominent.

Most patients have a combination of different types, and are usually best treated by combination therapy. It can be a fairly long process for the patient, and may require patience on the part of both the patient and the physician.

Depending on type of the scar, our options are:

• Small shallow scars - usually can be addressed by a filler injection

• Deep ice-pick scars, especially large ones - need to be excised and meticulously  reapproximated first, usually with subsequent dermabrasion or laser resurfacing.

• Dermabrasion has been a gold standard for treating extensive multiple scars. It is being gradually replaced by fractionated CO2 laser resurfacing. Among these, Deep FX is a promising new therapy for these patients. Sometimes several laser treatments are required, and occasionally dermabrasion followed by laser therapy is beneficial.

It is important to see a physician who has experience in treating these patients and who can offer you all of these options and recommend the right course of therapy.

Acne scars can be a very troubling problem. Even though the acne breakouts may be controlled or have long since stopped, the scarring remains for a lifetime.

Treatment for acne can be as troublesome as the disease itself. Usually, successful treatment requires a team approach with a dermatologist and a cosmetic surgeon.

First, attention must be turned to stopping any outbreaks, then repair of the scarring. If outbreaks continue, scarring is likely to continue, and any treatments aimed at treating scarring would be futile. There are many options for treatment of acne today depending on the severity of outbreaks. These are beyond the scope of this article, except to say that treatment for the underlying disease process is a must. Once the outbreaks are well controlled, attention can be turned toward erasing the lasting marks on the face.

Of note, acne is not only a disease of adolescence. Adult onset acne is not completely uncommon and is seen in women who are pregnant – often with more severe scarring. Treatment options for acne scars depend on the severity of the scarring and the skin type of the person wishing repair.

In people with darker skin, Fitzpatrick Types V, VI; options are limited because of concern for pigment irregularities after treatment. For lighter skinned individuals, treatments range from simple facial exfoliation to deep chemical or laser peels to surgical intervention.

For light scarring after acne, attention is placed on skin resurfacing. By taking off the outer layers of skin and stimulating collagen synthesis with new skin formation, acne scars can be reduced. This is best simulated by placing a finger on either side of an area of scarring and lightly pulling. If the scars fade, this can be a good option for resurfacing.

For deeper scars, a deep chemical peel, ablative laser (CO2 or erbium) resurfacing, or dermabrasion/dermasanding may be necessary. For deeper scars, deeper solutions are necessary. Again, several options exist.

• Deeper scars can be surgically excised with the larger acne scar replaced with a surgically placed small line. This can later be refined with other rejuvenation techniques.
• Punch grafting affords a simple method for treating multiple scars. A circular punch is used to create an incision around an acne scar. The scar is then allowed to heal and the resulting skin irregularity is smoothed.
• Subcision involves releasing the tethering attachments underneath the scar and then filling the space with either a temporary or permanent filler to prevent the scar from reforming when it heals. With the advent of new temporary artificial fillers such as hyaluronic acid, this is a good option for larger depressed scars.

Whatever the treatment option, it is important to consult a physician with a large arsenal of treatment options – if a physician only sells a cheeseburger, then you get sold a cheeseburger, even if you need a bacon burger. It is also important to remember that just as acne scars did not form overnight, treatment can sometimes take months to get the desired result. Once you find an experienced physician and decide on a treatment option, remember that it’s a long road but one that is usually worth the wait.